| NPI | 1811049919 |
|---|---|
| Former Name | MARCIA LYNN TAVARES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 6722) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-05-21 |